The AHD Model

AHD is the only rural health provider in Latin America that delivers quality care based on a proven model of self-sufficiency and capacity building. AHD offers the only residency program that trains rural family physicians — where local faculty train Ecuadorian physicians to work in their own communities.

AHD has been operating Pedro Vicente Maldonado (PVM) hospital and clinics for 20 years and has served more than 150,000 people. PVM has been financially self-sustaining since 2007. In 2014, AHD constructed a new health complex with a 60-bed hospital, outpatient facilities, and a training center at Hesburgh Hospital in a different part of the country, Santo Domingo.

In addition to adding critically needed hospital care to an area where 400,000 mostly poor people live, this new complex allowed AHD to expand its family medicine residency program from 6 doctors a year to 60, and to conduct meaningful public health research in the community. Both PVM and Hesburgh facilities are operated 100% by Ecuadorians.

We work with the local government, with US and Ecuadorian universities, and with donors around the world.

View Partners

Our facilities are 100% staffed with local Ecuadorians. In fact, Hospital Pedro Vicente Maldonado is the largest private employer in that town.

Working with and for the communities we serve instead of as an outside organization, drives a faster, more profound transformation of the healthcare system.

AHD’s facilities utilize a unique combination of local financing mechanisms and public-private partnerships in order to be financially self-sustaining: fees for service, payments from Ecuador’s Social Security Institute and Ministry of Health, contracts with local companies, and contributions from local municipalities.

This means that donations from the U.S. are used to expand the model and training programs, as opposed to paying for day-to-day operations at AHD’s facilities.

  • Hospital Pedro Vicente Maldonado – 100% Sustainable
  • Hesburgh Hospital – 95% Sustainable
  • Residency Programs – 85% Sustainable
  • Research Initiatives – 100% Sustainable

Our research agenda is ambitious and broad, focusing on public health issues that face our communities. We emphasize quantitative as well as qualitative research. Our partners include The University of Notre Dame’s Eck Institute, The University of Wisconsin’s Global Health Institute, Bellarmine University’s Department of Anthropology, and The Catholic University of Ecuador.

Our areas of research have focused on:

• Vector biology (mosquitos and arboviral infections)
• Tropical disease
• Antimicrobial resistance patterns
• Various aspects of COVID-19
• Mental health
• Medical anthropology
• Medical education

Our hospital in Santo Domingo has a full microbiology laboratory with PCR capability and -80 freezer. Our communities served by our healthcare systems are subtropical and tropical on the western slopes of the Andes. One community has 70,000 members and the other more than 400,000.

We also write medical manuals and attempt to introduce contextualized best practices in a challenging clinical environment. For example, we have treatment protocols established that our medical ICU utilizes. Our electronic medical record facilitates the use of protocols and allows for ongoing monitoring in real time.

Do you have a research idea? Let us know. Email We would be happy to discuss!

Quality Health Care: Hospitals Hesburgh & PVM

Hesburgh Hospital (HH) is a full service training facility in Santo Domingo, Ecuador. Its campus includes:

  • a residency program that trains 60 doctors a year
  • a simulation lab contextualized for rural Ecuador
  • two operating rooms
  • a full ER
  • a pharmacy
  • a laboratory
  • isolation wards
  • a neonatal unit
  • dental services
  • an ultrasound machine
  • a CT scanner
  • an MRI
  • a dorm for physician residents
  • in- and out-patient wings

HH serves every patient who comes through the door and each day, moves closer to financial break-even thanks to a public-private partnership with Ecuador’s Ministry of Health. HH opened in 2014, but we still are raising funds to realize the dream of a full service, financially self-sustaining teaching hospital.

AHD’s pilot project was a facility in the underserved community of Pedro Vicente Maldonado (PVM).  Hospital PVM opened in 2000, and by 2007, was financially self-sustaining. Hospital PVM provides high quality care to an extended community of 80,000 and is a training ground for physicians and other leaders in the local community. Today the hospital continues to be 100% financially self-sustaining.

Both hospitals also house the Ronald McDonald House Charities Safe Motherhood Program, which provides subsidized health services to low income mothers and babies.

Family Practice Residency Program

Only 15% of doctors in Ecuador have residency training, and the vast majority of these physicians live and work in the major cities. AHD trains Ecuadorian doctors in rural Family Medicine through a rigorous, 3-year residency program in partnership with the Catholic University of Ecuador.

Third-year residents of the program train subsequent classes of doctors. After graduation, the doctors work at an AHD hospital or another rural facility in Ecuador. As part of the “Saludesa Fellowship,” they receive continuing education, collaborate on research, and engage in policy discussion.

Andean Health Institute

AHD has created the Andean Health Institute (AHI) to support the AHD mission by systematically measuring the impact of its work, better understanding the determinants of health and disease in rural Latin America, and sharing the lessons learned with the larger public health community. AHI engages strategic operational and academic partners, and influences policies to provide quality, accessible, and sustainable health care in rural Latin America.

Strategic Areas of Focus for AHI

  1. Monitor and Measure. Evaluate AHD/Saludesa’s health and education outcomes and impact.
  2. Research. Research the principal public health threats to our communities, including perceptions of health and illness.
     Visit Práctica Familiar Rural, AHD’s online medical journal in Spanish to learn about recent research efforts. 
    — Read AHD’s Academic Publications in the U.S. below.
  3. Policy Leadership. Influence local, regional and global health practice and policy.

Current initiatives of the AHI


Spring 2022 News

We had a census of 50 hospitalized patients at Hesburgh Hospital in February: a new milestone. Where did they come from? Most came from Ecuador’s ministry of public health and social security systems.

Learn More >